Can you remember what you were doing in 1993? I can – I failed to get the job I thought I really, really wanted. What was the job? It was the out-patient services manager in a very large acute hospital. I wanted the job because I wanted to make things better. I had been handling complaints for a little while and by far the greatest number seemed to be about out-patients; the out-patient manager and I had a great relationship but we never seemed to be able to make things ‘better’. He was retiring and I wanted to ‘have a go’!
In 1993 the Patients Charter was published and we had a big push on reducing waiting times in clinics and starting using bar coding to record how long patients spent waiting. We even tried using some computer modelling to try to improve things but I’m not sure we really made any difference. I looked at complaints data for 2011-12 and 27% of complaints were still about out-patients . It started me wondering if we were making any real improvements and are we tackling the right issues?
How do I know that we didn’t improve things? First of all, my experience of clinics, as a patient, has barely changed since I first entered the healthcare system in 1979. Clinics are still the same in 2013 as 1979, with the possible exception that I am more likely to be seen more promptly. But I’m not sure this is what people who attend are really most concerned about.
This week a number of things happened that reminded me of all of this. While the media is alight with stories of 111, I have been thinking of more commonplace things. Out-patient clinics are important places. People’s lives are irrevocably changed in them; people are given life changing news, sometimes good and sometimes not so good and on occasions down right devastating. For me all clinic visits provoke anxiety and an institutionalised behaviour where I sometimes surprise myself. I become very compliant no matter what staff do, say or how they behave. Over the last few years, perhaps with increasing age I have been a bit more confident with the medical staff but I admit I’m scared of the reception staff. In addition I have never ever heard a doctor or nurse say ‘I’m so looking forward to clinic today’ – in fact this week a middle ranking doctor told me he hated being in clinic. I’m not sure if he is unusual or not.
This week this brilliant inspired posting on Patient Opinion reminded me of all of this – clearly I am not alone. Please follow this link and read this feedback:
https://www.patientopinion.org.uk/opinions/94942
The same week that I read this I also tripped up over a blog by a medic that I really liked. He was reflecting on the experience of withdrawing money in India from a bank and compared this to the admission process here at home – I think he has a point and what’s more it also applies to many types of out-patient clinic. I have stopped asking for the ‘one-stop-clinic’ where I can get everything done too – I just suffer the shuffle from one waiting chair to the next.
http://britishgeriatricssociety.wordpress.com/2013/04/29/streamlining-admissions/
Another blogger @mandyhall84 also describes her experiences here:
http://geektapestry.wordpress.com/2013/05/01/how-to-blob-the-square-of-the-op-process/
A lot of people visit out-patients – if I’ve got this right from the HSCIC information, there were around 6.5 million visits to out-patients in 2011/12 – that’s a big number. A review of issues relating to ‘appointments’ on Patient Opinion show a mixed bag of excellent to poor feedback.
In all the time I have had diabetes I have never met another person with diabetes or a pump in the clinic area. I believe there is great scope for improving things and using at least some clinics in different ways to support patients. I feel confident that if the new modern out-patient staff had vision they would consider using a co-production approach to reviewing how we deliver these services – maybe they are? Perhaps it’s just my personal experience, and I don’t like to generalise, but finally I would like to leave you with this paper by John Launer, whose writing I greatly admire:
http://pmj.bmj.com/content/88/1040/361.full
Why are we still getting it so wrong?
anniecoops 
If someone is doing it, Annie, we’re not hearing or seeing it.
I dread being referred to OP for anything. And a lot of the changes won’t cost much – if anything, to make as the information is already there.